New criteria of normal serum lipid levels in Japanese children: the nationwide study

Age- and Gender-Specific Reference Intervals for the Fasting Serum Lipid Levels in a Pediatric Population Aged 0-＜15 Years in Nanjing, China

AIMS

The lipid reference intervals (RIs) that are currently used for children in China are not based on studies of the local population and normally do not consider age or gender differences. This study aimed to establish age- and sex-specific RIs for the fasting serum lipid levels in the pediatric population aged 0 - 15 years in Nanjing, China.

METHODS

5,866 children aged 3 days to ＜15 years were recruited to establish serum lipid RIs, and the triglyceride (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) levels were analyzed using the Roche cobas702 automatic biochemical analyzer. Low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (nHDL-C) levels were calculated (LDL-C=TC-HDL-C-TG/5, and nHDL-C=TC-HDL-C). Smoothed percentile curves for the boys and girls were generated using the LMS method. Age- and sex-specific RIs were the determined according to the methods recommended by the Clinical and Laboratory Standards Institute EP28-A3c guidelines.

RESULTS

This study showed that the serum lipid levels varied considerably throughout childhood and adolescence, with sex differences, especially in infants aged less than 2 years and puberty. Based on the Harris-Boyd method, sex partitions were required for ages ＜6 months in the TC indicator and for ages ≤ 28 days in LDL-C and nHDL-C. Age partitions were also required for all serum lipid parameters.

CONCLUSIONS

We established age- and sex-specific RIs for TG, TC, HDL-C, LDL-C, and nHDL-C parameters in children aged 0 days to ＜15 years in Nanjing, China. These data are thus considered to be useful for the screening of dyslipidemia in children and adolescents.

An Alternative Approach to Determining Metabolic Syndrome Component Cutoffs in Children and Adolescents Using Segmental Regression Analysis

Background: The prevalence of metabolic syndrome is increasing in children and adolescents. Although some diagnostic criteria for metabolic syndrome exist, further research is needed to determine appropriate age-, sex-, and race-specific cutoffs for each component. Methods and Results: Health examinations were conducted in 1,679 children aged 6-15 years in 9 regions of Japan. Participants were divided into 3 age groups for each sex: 6-8, 9-11, and 12-15 years. For metabolic syndrome components in each group, inverse cumulative percentile graphs were drawn and approximated by 3 regression lines using segmented regression analysis. The intersection of each regression line was defined as the breakpoint, and the measured value corresponding to the breakpoint percentile as the breakpoint value. Breakpoint values for waist circumference were age dependent at approximately 60, 70, and 80 cm for ages 6-8, 9-11, and 12-15 years, respectively. Breakpoint values for blood pressure were age- and/or sex dependent, while those for triglycerides, high-density lipoprotein cholesterol, and fasting blood glucose were neither age nor sex dependent. Based on these results, we proposed new cutoffs for diagnosing metabolic syndrome in Japanese children and adolescents. Conclusions: Breakpoint values obtained by segmented regression analysis on inverse cumulative percentile graphs can be useful for determining metabolic syndrome component cutoffs in children and adolescents.

[Incidence and cause of abnormal cholesterol in children aged 2-18 years in a single center]

OBJECTIVE

To investigate the abnormality and distribution of plasma cholesterol levels in single-center hospitalized children.

METHODS

The blood lipid levels of children aged 2-18 years who had blood lipid test results in Peking University First Hospital from June 2016 to June 2019 were etrospectively analyzed. Cholesterol oxidase method was used for total cholesterol, and high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were detected by clearance method. The counting data were compared with chi-square test.

RESULTS

The survey had involved 11 829 children (7 087 were boys and 4 742 were girls). 1 822 (15.4%) children were with elevated total cholesterol, 1 371 (11.6%) children with elevated low-density lipoprotein cholesterol, and 2 798 (23.7%) children with high-density lipoprotein cholesterol reduction. The total number of the children with abnormal cholesterol levels was 4 427 (37.4%). Among the 7 835 children who visited hospital due to the disease not commonly inducing dyslipidemia, 731 (9.3%) had elevated TC, 561 (7.2%) had elevated LDL-C, 1 886 (24.1%) had decreased HDL-C, and 2 576 (32.9%) had abnormal cholesterol levels. Among the children with different diseases, the difference in the incidence of abnormal cholesterol was statistically significant. The top three main groups of the children with increased total cholesterol and low-density lipoprotein cholesterol were "dyslipidemia", "urinary tract disease", and "nutritional disease"; The top three main groups of the children with reduced high-density lipoprotein cholesterol were "respiratory diseases", "dyslipidemia", "hematological diseases and malignant tumors". Among the 1 257 blood li-pid test results sent by other departments, 300 cases had abnormal cholesterol levels (23.8%). Among them, there were 70 children with hypercholesterolemia (5.6%), 44 children with increased low-density lipoprotein cholesterol (3.5%), and 224 children with reduced high-density lipoprotein cholesterol (17.8%). There were 365 (4.6%) children with low-density lipoprotein cholesterol ≥140 mg/dL (3.6 mmol/L) who needed to further exclude familiar hypercholesterolemia among the children who visited hospitals due to the disease not commonly inducing dyslipidemia.

CONCLUSION

Children in hospitals have a high incidence of cholesterol abnormalities. Doctors need to pay more attention to the cholesterol diagnosis and management regardless of the discipline, which not only helps to control secondary hypercholesterolemia, but also provides the possibility of detecting familial hypercholesterolemia in time.

Identification of Factors Influencing Cholesterol Changes in Elementary-School Children: A Longitudinal Study

Changes in serum cholesterol levels during childhood may affect the risk of cardiovascular disease in adulthood. However, cholesterol level changes in Japanese children and adolescents and the factors that influence them have not been completely elucidated. This study aimed to determine whether cholesterol levels changed due to the effects of growth and identify factors. This cohort study included elementary-school children in the fourth grade (9−10-year-old) who underwent assessments of cholesterol levels and demographic and lifestyle characteristics. The participants were followed up in their first year of junior high school with the same laboratory, demographic, and lifestyle assessments. From the fourth year of elementary school to the first year of junior high school, children’s cholesterol levels decreased (p < 0.0001). Regarding bowel movements, cholesterol level reduction was significant in individuals with regular bowel movements but not significant in those with infrequent bowel movements. Weight was the factor that most strongly negatively predicted cholesterol level reduction (p < 0.001). The study demonstrated the significance of lifestyle factors for growth-related changes of total cholesterol levels and identified weight as the factor that most strongly influenced total cholesterol level changes. Guidance regarding lifestyle improvements should be imparted to children from the fourth grade of elementary school.

Investigation of the Reference Interval Values of Fasting Plasma Glucose, Blood Pressure, and Blood Lipids in the Longevity People Aged 90 Years Old and Above

PURPOSE

To our knowledge, the normal fasting plasma glucose (FPG), blood pressure (BP), and blood lipids (BL) interval values have not been well-established in the longevity population. This study aims to provide a reference for the establishment of normal BP, FPG, and BL interval values in the longevity people in China.

PATIENTS AND METHODS

A total of 7417 people were selected from the natural longevity cohort in Guangxi, with an age range of 20-110 years old, including 7093 classified as the non-longevity (20-89 years old) (94.02%) and 324 classified as the longevity (≥90 years old) (5.98%); there were 4309 men (58.1%) and 3108 women (41.9%). FPG, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), and low-density lipoprotein (LDL-C) levels were defined as desirable levels when they were below the 75th percentile (P75), borderline levels from the 75th to 90th percentile (P75-P90), and high levels above P90; triglyceride (TG) levels above P90 were defined as high; and high-density lipoprotein cholesterol (HDL-C) levels below the 5th percentile (P5) were defined as low levels.

RESULTS

The reference interval values of FPG in the longevity were as follows: desirable levels <6.15 mmol/L, borderline levels 6.15-7.45 mmol/L, high levels ≥7.45 mmol/L. Reference interval values of systolic blood pressure (SBP) were as follows: desirable levels <160.00 mmHg, borderline levels 160.00-174.50 mmHg, high levels ≥175.00 mmHg. DBP reference interval values were as follows: desirable levels <88.00 mmHg, borderline levels 88.00-90.00 mmHg, high levels ≥90.00 mmHg. TC reference interval values were as follows: desirable levels <5.59 mmol/L, borderline levels 5.59-6.45 mmol/L, high levels ≥6.45 mmol/L. LDL-C reference interval values were as follows: desirable levels <3.30 mmol/L, borderline levels 3.30-3.85 mmol/L, high levels ≥3.85 mmol/L. TG reference interval values were as follows: desirable levels <2.82 mmol/L, high levels ≥2.82 mmol/L. HDL-C reference interval values were as follows: low levels <0.80 mmol/L, desirable levels ≥0.80 mmol/L.

CONCLUSION

The reference interval values of BP, FPG, and BL are different between the longevity population and the non-longevity population, and the interval values change with increasing age.

The dynamics of metabolic syndrome development from its isolated components among iranian children and adolescents: Findings from 17 Years of the Tehran Lipid and Glucose Study (TLGS)

BACKGROUND

Careful evaluation of the progression trend of the metabolic syndrome (MetS) in children and adolescents (C&A) is one of the important methods of studying the natural history of MetS in them. This study was performed to determine the trend of changes in the progression of MetS from its components.

METHODS

This was a longitudinal study which was performed on data from 4 follow-up periods of Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 6-18-year-old children and adolescents creating 3895-person population. The criteria for the diagnosis of MetS was joint interim statement (JIS). The considered components were central adiposity, high blood pressure, insulin resistance, and dyslipidemia.

RESULTS

In this study, in the long term, the highest increase in the MetS' incidence in boys occurred in obesity and in girls in dyslipidemia and in total mode, in obesity. But in the short term (3.6 year follow-up periods) in the first to fourth periods, in total mode, the highest incidence occurred in dyslipidemia, hyperglycemia, dyslipidemia, and obesity. In terms of trend, in total mode, the highest increase in MetS incidence was related to the obesity component. Also, the incidence of MetS from all components was declining in overall mode. Also, the most common components at the beginning and end of the study in all groups were dyslipidemia with a decreasing and obesity with an increasing trend, respectively.

CONCLUSION

It seems that in Iranian C&As, obesity and dyslipidemia components play a more important role in the further development of the MetS than other components. This matter requires careful and serious attention in preventive and control planning.

The Hekinan Children's Study: Design and Profile of Participants at Baseline

BACKGROUND

The early life environment is now recognized as a key factor contributing to susceptibility to certain diseases in later life.

METHODS

We initiated a cohort study among school children in 2011 to primarily investigate the associations between lifestyle and environmental factors and some surrogate markers of chronic diseases, such as cardiometabolic risk factors (ie, obesity, high blood pressure, high blood glucose, insulin, or lipids) and cancer risk factors (ie, height and age at menarche). A baseline questionnaire asked for information, including demographic variables, medical history and use of medication, dietary habits, physical activity, sleep habits, and behavioral and emotional problems of children. Follow-up surveys are planned for the fourth grade of elementary school and the first grade of junior high school. At these follow-up surveys, fasting blood samples will be obtained to measure cardiometabolic markers. We also checked the validity of a food frequency questionnaire, which was originally created for 6-year-olds but was modified for use in older children.

RESULTS

A total of 3,141 first-year students at elementary schools in Hekinan City, Aichi Prefecture, participated in the study. The response rate was 87.4%. The means of age and body mass index were 6.99 (standard deviation, 0.28) years and 15.3 (standard deviation, 1.7) kg/m2, respectively, in the 3,067 Japanese children (1,639 boys and 1,428 girls).

CONCLUSIONS

This cohort will reveal determinants of cardiometabolic risk factors and cancer risk factors during childhood.

Total body irradiation for hematopoietic stem cell transplantation during early childhood is associated with the risk for diabetes mellitus

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) is a curative treatment for life-threatening malignancies and related diseases. Recently, the long-term prognosis of HSCT during childhood has greatly improved; however, the late adverse effects of HSCT have been found to cause substantial morbidity among long-term survivors. Although metabolic complications, such as diabetes mellitus (DM) and hyperlipidemia (HL), are the major late effects of pediatric HSCT, the clinical details are not clarified sufficiently.

METHODS

From 1983 to 2013, 75 participants underwent HSCT in our institute because of malignant or other related diseases. We retrospectively evaluated metabolic complications of eligible 22 participants (14 men and 8 women), and their clinical backgrounds.

RESULTS

Among 22 participants, 4 and 9 participants developed DM and HL after HSCT, respectively, and all participants with DM developed HL. None of the participants with DM were obese, and all had substantial insulin resistance. Total body irradiation (TBI) was performed in 10 participants, including 4 participants with DM and 5 participants with HL, revealing that TBI is an independent risk factor for DM. The age at TBI for participants with DM was significantly lower than that for participants without DM (p = 0.01), and all participants with DM received TBI before the age of 6.

CONCLUSIONS

Our data suggested that TBI was a risk factor for DM after HSCT, and TBI before the age of six increased the possibility of DM without obesity.

Guidelines for Diagnosis and Treatment of Familial Hypercholesterolemia 2017

Statement1. Familial hypercholesterolemia (FH) is an autosomal hereditary disease with the 3 major clinical features of hyper-LDL-cholesterolemia, premature coronary artery disease and tendon and skin xanthomas. As there is a considerably high risk of coronary artery disease (CAD), in addition to early diagnosis and intensive treatment, family screening (cascade screening) is required (Recommendation level A) 2. For a diagnosis of FH, at least 2 of the following criteria should be satisfied:① LDL-C ≥180 mg/dL, ② Tendon/skin xanthomas, ③ History of FH or premature CAD within 2nd degree blood relatives (Recommendation level A) 3. Intensive lipid-lowering therapy is necessary for the treatment of FH. First-line drug should be statins. (Recommendation level A, Evidence level 3) 4. Screening for CAD as well as asymptomatic atherosclerosis should be conducted periodically in FH patients. (Recommendation level A) 5. For homozygous FH, consider LDL apheresis and treatment with PCSK9 inhibitors or MTP inhibitors. (Recommendation level A) 6. For severe forms of heterozygous FH who have resistant to drug therapy, consider PCSK9 inhibitors and LDL apheresis. (Recommendation level A) 7. Refer FH homozygotes as well as heterozygotes who are resistant to drug therapy, who are children or are pregnant or have the desire to bear children to a specialist. (Recommendation level A).

Effects of Growth Hormone Treatment on Lipid Profiles

OBJECTIVES

To assess the effects of growth hormone (GH) on lipid profiles in children and whether the effect is pharmacological.

METHODS

The authors determined serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and low-density lipoprotein cholesterol (LDL-C) every year during 3-y GH treatment in 48 GH deficient (GHD) short children and 22 children with short stature born small for gestational age (SGA).

RESULTS

The abnormally high levels of TC, non-HDL-C, and LDL-C showed a high frequency in GHD short children compared with epidemiological studies in Japan. The high prevalence of high level of TC was also shown in SGA short children. Three-year GH treatment decreased serum TC, non-HDL-C, and LDL-C levels in both patient groups.

CONCLUSIONS

GH treatment is clearly a pharmacological therapy in SGA short children and so may also be in GHD short children at the Japanese standard therapeutic dose. Taken together, GH improves lipid profiles, and its effect has the possibility of medical properties.

Evaluation of Hip/HeightP Ratio as an Index for Adiposity and Metabolic Complications in Obese Children: Comparison with Waist-related Indices

Aim: To investigate whether body adiposity index (BAI; hip/height^1.5–18), pediatric BAI (BAIp; hip/height^0.8–38), and other hip/height^P ratios are useful in obese children.

Method: Ninety obese Japanese children, 55 boys and 35 girls, who visited our University Clinic, were enrolled. The age was 9.92 ± 2.6 (mean ± SD) years, and the percentage overweight (POW) was 51.6 ± 18.8%. We set the power value of the hip/height^P 0, 0.5, 0.8, 1, 1.5, and 2 and studied the association with overweight indices, biochemical data, and fat area measured by computed tomography. Waist, waist/height ratio, and waist/hip ratio were also evaluated.

Results: Hip/height and hip/height^0.8 (BAIp) were more closely correlated with POW, body mass index percentile, and percentage body fat than hip/height^1.5 (BAI). The correlation coefficient of hip/height with POW (r = 0.855) was the highest among the studied hip/height^P indices. The approximate line to predict POW was 411 × hip/height−207. The waist/height was also highly correlated with POW (r = 0.879). Hip and hip/height^0.5 were more closely correlated with visceral fat area than hip/height, BAIp, and hip/height^1.5. Hip and hip/height^0.5 were significantly correlated with insulin. Only hip was also significantly associated with dyslipidemia. All hip/height^P indices were not significantly correlated with alanine aminotransferase (ALT). Waist was significantly correlated with serum lipids, ALT, and insulin.

Conclusion: Hip/height and BAIp are better markers for overweight (adiposity) in obese children than BAI. However, hip/height, BAIp, and BAI are not useful to predict metabolic complications. Waist appears to be the best index for obese children overall at this time.

Usefulness of non-fasting lipid parameters in children

BACKGROUND

This study assessed whether non-fasting lipid markers could be substituted for fasting markers in screening for dyslipidemia, whether direct measurement of non-fasting low-density lipoprotein cholesterol [LDL-C (D)] could be substituted for the calculation of fasting LDL-C [LDL-C (F)], and the utility of measuring non-high-density lipoprotein cholesterol (non-HDL-C).

METHODS

In 33 children, the lipid profile was measured in the non-fasting and fasting states within 24 h. Correlations were examined between non-fasting LDL-C (D) or non-HDL-C levels and fasting LDL-C (F) levels.

RESULTS

Non-fasting triglyceride (TG), total cholesterol (TC), HDL-C, LDL-C (D), and non-HDL-C levels were all significantly higher than the fasting levels, but the mean difference was within 10% (except for TG). Non-fasting LDL-C (D) and non-HDL-C levels were strongly correlated with the fasting LDL-C (F) levels.

CONCLUSIONS

In conclusion, except for TG, non-fasting lipid parameters are useful when screening children for dyslipidemia. Direct measurement of non-fasting LDL-C and calculation of non-fasting non-HDL-C could replace the calculation of fasting LDL-C because of convenience.

Serum Lipid Profile, Prevalence of Dyslipidaemia, and Associated Risk Factors Among Northern Mexican Adolescents

BACKGROUND

The increase in overweight and obese children and adolescents may be linked to increased rates of dyslipidaemia. The aim was to assess the serum lipid profile, the prevalence of dyslipidaemia, and associated risk factors among the North Mexican adolescent population.

METHODS

Two hundred and ninety-three subjects (47.8% girls) ages 11 to 16 years took part in the Nuevo León State Survey of Nutrition and Health 2011-2012. According to the 2011 Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, dyslipidaemia was defined as a presence of ≥1 of the following levels (mg/dL): Total cholesterol ≥200, low-density lipoprotein cholesterol ≥130, non-high-density lipoprotein cholesterol <40, and triglyceride ≥130.

RESULTS

The overall frequency of dyslipidaemia was 48.8% with no differences between sexes. Adolescents with high body mass index were more likely to have at least 1 abnormal lipid level (overweight: odds ratio [OR]: 2.07; 95% confidence interval [CI]: 1.14-3.77, P < 0.05; obesity: OR: 2.21, 95% CI: 1.11-4.41, P < 0.05) than those with normal weight. Abdominally subjects with obesity were also more likely to have at least 1 abnormal lipid level (OR: 2.30; 95% CI: 1.35-3.91, P < 0.01) than their leaner counterparts.

CONCLUSIONS

Half of Mexican adolescents living in the State of Nuevo León have at least 1 abnormal lipid concentration. Low HDL-chol level was the most common dyslipidaemia. Body mass index and abdominal obesity were associated with the prevalence of at least 1 abnormal lipid level.

Non-high-density lipoprotein cholesterol as a cardiovascular risk screening tool in children

BACKGROUND

Non-high-density lipoprotein cholesterol (non-HDL-C) is now recognized as a strong predictive factor for cardiovascular disease in adults, but there have been few reports on non-HDL-C in children.

METHODS

A total of 5853 4th and 7th grade schoolchildren were included in the screening for lifestyle-related disease from 2010 to 2011 in Takaoka City. The children underwent anthropometric measurements and non-fasting blood tests to measure total cholesterol (TC), HDL-C, triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C). The relationship between percent overweight and each lipid level was analyzed, and children above the 97th percentile level with respect to both TC (220 mg/dL) and non-HDL-C (152 mg/dL) were compared and assessed. The relationship between non-HDL-C and the prevalence of metabolic syndrome was also analyzed among 150 obese children.

RESULTS

Non-HDL-C positively correlated with percent overweight and TG rather than did TC (r = 0.273, 0.360 vs 0.118, 0.179, all P < 0.001). In the screening using TC criteria, several subjects with increased HDL-C were miscategorized as hyperlipidemic, whereas none were miscategorized using the non-HDL-C criteria. The sensitivity of the identification of increased LDL-C was lower when the criteria for TC were used rather than the criteria for non-HDL-C (80.8% vs 98.3%). Among obese children, the prevalence of metabolic syndrome increased significantly and was accompanied by an increase in non-HDL-C (P = 0.009).

CONCLUSION

Instead of TC, non-HDL-C would serve as a better and useful cardiovascular risk screening tool for lifestyle-related disease in school children.

Importance of both fatness and aerobic fitness on metabolic syndrome risk in Japanese children

Associations between body mass index (BMI), peak oxygen consumption (VO(2peak)), and metabolic syndrome (MetS) risk factors have not been adequately studied in Japanese children. Here the relationships between these parameters and the threshold aerobic fitness level necessary for low MetS risk were determined. The participants (299 children; 140 boys and 159 girls, aged 9.1 ± 0.3 years) were divided into four groups using the medians of predicted VO(2peak) (pVO(2peak)) and BMI. MetS risk scores were calculated using z-scores. Receiver Operating Characteristic analysis was used to determine the threshold aerobic fitness level necessary for low MetS risk. The MetS risk score of the High BMI group was significantly higher than that of the Low BMI group for both sexes (p < 0.0001). However, the High BMI/High Fitness group had a significantly lower MetS risk score than the High BMI/Low Fitness group for both sexes. The (p)VO(2peak )cut-off values for low MetS risk were 47.9 and 44.9 ml/kg/min for boys and girls, respectively. Our results suggest that improvements in both fatness and aerobic fitness are important for decreasing MetS risk. We also confirmed the (p)VO(2peak) of cut-off values necessary for low MetS risk in Japanese children.

Prevalence of dyslipidemia in Iranian children and adolescents: A systematic review

BACKGROUND

Dyslipidemia is considered as an important modifiable risk factor for cardiovascular disease (CVD). The link between childhood dyslipidemia and occurrence of atherosclerosis and its sequels in adulthood are well-documented. This study aimed to systematically review the prevalence of dyslipidemia among Iranian children and adolescents.

MATERIALS AND METHODS

An electronic search was conducted on studies published from January 1990 to January 2014. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS. For Persian databases, we used domestic databases with systematic search capability including IranMedex, Irandoc, and Scientific Information Database (SID). We included all available population-based studies and national surveys conducted in the pediatric age group (aged <21 years).

RESULTS

In this review, 1772 articles were identified (PubMed: 1464; Scopus: 11; ISI: 58; SID: 90; IranMedex: 149; Irandoc: 57). During three refine steps and after removing of duplicates, 182 articles related to the study domain were selected. After quality assessment, 46 studies were selected for text appraisal, of which 26 qualified articles were evaluated at the final step. The prevalence range of hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol (HDL-C) were 3-48%, 3-50%, 5-20% and 5-88%, respectively. Low HDL-C and hypertriglyceridemia were the most prevalent lipid disorders in this group of population.

CONCLUSION

Dyslipidemia is a common health problem among Iranian children and adolescents. Few data were available in preschool children. This finding provides useful information for health policy makers to implement action-oriented interventions for prevention and early control of this important CVD risk factor.

Reference Ranges for the Non-High-Density Lipoprotein Cholesterol Levels in Japanese Children and Adolescents

AIM

The aim of this study was to identify the age and sex-specific reference ranges for the non-high-density lipoprotein cholesterol (non-HDLC) levels in Japanese children.

METHODS

The subjects included 441,431 schoolchildren (207,015 boys, 234,416 girls) 9-16 years of age who participated in a screening and care program for lifestyle-related diseases from 2006 to 2011. The serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels were measured, and the non-HDL-C levels were calculated. The serum lipid levels were analyzed according to age and sex.

RESULTS

The overall mean non-HDL-C level was 105.7±24.0 mg/dL, with a sex difference: boys= 103.0±24.0 mg/dL and girls=108.2±23.8 mg/dL. In boys, the median non-HDL-C level decreased gradually from 104 mg/dL in the 9-year-old age group to 96 mg/dL in the 15-year-old age group. The 75th percentile level was approximately 120 mg/dL in the 9- to 11-year-old groups and decreased at approximately 113 mg/dL in the 12- to 15-year-old groups, whereas the 95th percentile level was approximately 150 mg/dL in the 9- to 11-year-old groups and decreased at approximately 140 mg/dL in the 13- to 15-year-old groups. In girls, the median non-HDL-C level remained unchanged at approximately 105 mg/dL, with 75th and 95th percentile levels of approximately 122 and 150 mg/dL, respectively.

CONCLUSIONS

The non-HDL-C levels vary by age and sex. The age- and sex-specific reference ranges for the non-HDL-C levels may be a valuable tool for management with respect to preventing the development of atherosclerosis in childhood.

LDL-cholesterol and body mass index among Japanese schoolchildren: a population-based cross-sectional study

Background

Serum low-density lipoprotein cholesterol (LDL-C) is one of the most important risk factors for coronary heart disease. The aim of the present study was to investigate the relationship between LDL-C and body mass index (BMI) in population-based Japanese schoolchildren.

Methods

The subjects comprised all fourth graders and seventh graders in Ina Town, Saitama Prefecture, Japan, during 2002-2009. Information about each subject’s age, sex, and family history of hypercholesterolemia was collected using a self-administered questionnaire. The body height, weight, and LDL-C were measured for each child. LDL-C was measured using the direct method. According to the LDL-C criteria of the Japan Atherosclerosis Society, LDL-C level was categorized into three subgroups: acceptable, < 110 mg/dL; borderline, 110-139 mg/dL; and high, ≥ 140 mg/dL. Children with either borderline or high LDL-C level were considered to have high-normal LDL-C (HLDL-C).

Results

Data from a total of 5869 subjects were analyzed. A higher BMI category was associated with a higher prevalence of HLDL-C regardless of sex or grade level (P < 0.05). When compared with the <50th percentile BMI category, the odds ratio (OR) for HLDL-C was statistically significant in the 75th to 84th percentile category of fourth-grade boys (OR: 1.95, 95% confidence interval (95% CI): 1.28-2.97), the 85th to 94th percentile of fourth-grade girls (2.52, 1.74-3.64), and the 85th to 94th percentile of seventh-grade boys (2.04, 1.31-3.20) and girls (1.90, 1.24-2.91).

Conclusion

A statistically significant association between LDL-C levels and BMI was observed in Japanese school children.

Association of rapid weight gain during early childhood with cardiovascular risk factors in Japanese adolescents

Background

Because of the lack of relevant data, we investigated the association between rapid weight gain (RWG) during early childhood and cardiovascular risk factors in Japanese adolescents.

Methods

The source population comprised 2285 adolescents aged 13 to 14 years enrolled in any public school in Fukuroi City, Japan during 2008, 2009, or 2010. Since there are no private schools in this city, almost all adolescents who lived in the city went to 1 of these schools. We obtained data on blood pressure (BP), serum lipids, and anthropometry during adolescence, as well as anthropometry at birth, age 1.5 years, and age 3 years, from the Maternal and Child Health Handbook for 1624 children. RWG was defined as a change in body-weight standard deviation score greater than 0.67 from age 0 to 1.5 years or from age 1.5 to 3 years.

Results

After adjusting for confounding factors, adolescents who had RWG from 0 to age 1.5 years or from age 1.5 to 3 years were more likely to be overweight. Adolescents who had RWG during both periods were more likely to be overweight (odds ratio [OR], 6.37; 95% CI, 3.06–13.24), have unfavorable lipid concentrations (OR, 2.03; 95% CI, 1.15–3.58), and have high BP (OR: 2.36, 95% CI: 1.34–4.13). The associations with unfavorable lipid concentrations and high BP disappeared after further adjusting for current body mass index.

Conclusions

RWG during early childhood predicts unfavorable lipid concentrations and high BP in Japanese adolescents, and this relationship is mediated by body mass index in later life.

Serum lipid concentrations, prevalence of dyslipidemia, and percentage eligible for pharmacological treatment of Korean children and adolescents; data from the Korea National Health and Nutrition Examination Survey IV (2007-2009)

Objectives

Dyslipidemia is one of the important modifiable risk factors for cardiovascular disease. Thus, to know the prevalence of dyslipidemia is the 1^st step to make guidelines of screening and management plan. Although, American Academy of Pediatrics updated the guidelines for lipid in childhood, Asian study is rare.

Methods

The authors aimed to make a reference of each serum lipid level of Korean children and adolescents (2,363 subjects aged 10 to 18 years) from the data of Korea National Health and Nutrition Examination Survey IV (2007–2009).

Results

The mean serum concentrations for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were 158 mg/dL, 90 mg/dL, 90 mg/dL, and 49 mg/dL, respectively. The 95th percentile values for TC, LDL-C, and TG were 203 mg/dL, 129 mg/dL, and 185 mg/dL, respectively. The 5th percentile value for HDL-C was 36 mg/dL. The prevalence of hypercholesterolemia, high LDL-C, high TG, and low HDL-C was 6.5%, 4.7%, 10.1%, and 7.1%, respectively. Considering the risk factors such as obesity, hypertension, smoking, and diabetes, approximately 0.41% of the subjects were potentially eligible for pharmacological treatment.

Conclusions

This information may be useful in not only Korean but also Asian planning programs for the prevention of cardiovascular disease through lipid control from childhood.

Guidelines for the management of familial hypercholesterolemia

Familial hypercholesterolemia (FH) is a highly prevalent autosomal dominant hereditary disease, generally characterized by three major signs, hyper-low-density-lipoprotein (LDL) cholesterolemia, tendon/skin xanthomas and premature coronary artery disease (CAD). Because the risk of CAD is very high in these patients, they should be identified at an early stage of their lives and started on intensive treatment to control LDL-cholesterol. We here introduce a new guideline for the management of FH patients in Japan intending to achieve better control to prevent CAD. Diagnostic criteria for heterozygous FH are 2 or more of 1) LDL-cholesterol ≥180 mg/dL, 2) tendon/skin xanthoma(s), and 3) family history of FH or premature CAD within second degree relatives, for adults; and to have both 1) LDL-cholesterol ≥140 mg/dL and 2) family history of FH or premature CAD within second degree relatives, for children. For the treatment of adult heterozygous FH, intensive lipid control with statins and other drugs is necessary. Other risks of CAD, such as smoking, diabetes mellitus, hypertension etc., should also be controlled strictly. Atherosclerosis in coronary, carotid, or peripheral arteries, the aorta and aortic valve should be screened periodically. FH in children, pregnant women, and women who wish to bear a child should be referred to specialists. For homozygotes and severe heterozygotes resistant to drug therapies, LDL apheresis should be performed. The treatment cost of homozygous FH is authorized to be covered under the program of Research on Measures against Intractable Diseases by the Japanese Ministry of Health, Labour, and Welfare.

Association of changes in body fatness and fatty acid composition of plasma phospholipids during early puberty in Japanese children

AIMS

Plasma fatty acid composition can change with age, reflecting diet and levels of desaturating enzymes such as stearoyl-CoA desaturase (SCD), delta-6 desaturase (D6D) and delta-5 desaturase (D5D), which contribute to the development of insulin resistance. This study analyzed longitudinal changes in fatty acid composition in Japanese children during early puberty and the association between changes in desaturase indices and changes in body fatness and insulin resistance.

METHODS

The study included 77 children (38 boys and 39 girls) aged 9.6±0.5 years. Relative weight (RW) and waist-to-height ratio (WHtR) were determined. The fatty acid composition of plasma phospholipids was analyzed by gas chromatography, and the desaturase indices were calculated: SCD (16:1n-7/16:0: SCD16 and 18:1n-9/18:0: SCD18), D6D (20:3n-6/18:2n-6) and D5D (20:4n-6/20:3n-6) in 2006 and 2009.

RESULTS

Obese children showed higher dihomo-gamma linolenic acid (DGLA; 20:3n-6), a higher D6D index and lower D5D index than non-obese children. Longitudinal changes in fatty acid com-position were generally similar in both sexes. Increased D6D index and DGLA and decreased D5D index were significantly associated with increased WHtR in boys and girls. In addition, increased D6D index was associated with an increased homeostasis model of assessment ratio (HOMA-R) only in girls.

CONCLUSION

The change in abdominal adiposity is a determinant of longitudinal changes in D6D and D5D indices and DGLA during early puberty.

Favorable impact of growth hormone treatment on cholesterol levels in turner syndrome

Background: Patients with Turner syndrome (TS) are prone to having metabolic abnormalities, such as obesity, dyslipidemia, hypertension, hyperinsulinemia and type 2 diabetes mellitus, resulting in increased risks of developing atherosclerotic diseases. Objective: To determine the effect of growth hormone (GH) therapy on serum cholesterol levels in prepubertal girls with TS enrolled in the Turner syndrome Research Collaboration (TRC) in Japan. Patients and methods: Eighty-one girls with TS were enrolled in the TRC, and their total cholesterol (TC) levels before GH therapy were compared with reported levels of healthy school-aged Japanese girls. TC levels after 1, 2 and 3 yr of GH treatment were available for 28 of the 81 patients with TS. GH was administered by daily subcutaneous injections, 6 or 7 times/wk, with a weekly dose of 0.35 mg/kg body weight. Results: Baseline TC levels revealed an age-related increase in TS that was in contrast to healthy girls showing unchanged levels. During GH therapy, TC decreased significantly after 1 yr of GH treatment and remained low thereafter. Conclusions: Girls with untreated TS showed an age-related increase in TC that was a striking contrast to healthy girls, who showed unchanged levels. GH therapy in girls with TS brought about a favorable change in TC that indicates the beneficial impact of GH on atherogenic risk.

Favorable Impacts of Growth Hormone (GH) Replacement Therapy on Atherogenic Risks in Japanese Children with GH Deficiency

Growth hormone (GH) affects body composition and atherogenic risk factors. Severe hyperlipidemia may develop in GH-deficient adults as a consequence of continuous GH deficiency. We investigated changes in lipid profiles in 158 Japanese children (103 boys and 55 girls) with GH deficiency who had been enrolled in the Pfizer International Growth Database Japan during 3 yr of GH replacement therapy to evaluate whether GH treatment has beneficial effects on atherogenic risk factors. Total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC) and atherogenic index were evaluated before treatment and then once a year during treatment. The mean baseline TC was within the normal range in both boys and girls. Seventeen (16.5%) of the 103 boys and 18 (32.7%) of the 55 girls, however, had a TC level over 200 mg/dl before treatment. The mean TC level showed a significant decrease in girls. In a separate analysis, patients of both sexes with a TC level > 200 mg/dl showed significantly decreased TC. LDLC decreased significantly only in girls, while HDLC showed no change in either sex. The atherogenic index decreased significantly in girls. GH replacement therapy in children with GH deficiency had beneficial effects on lipid metabolism and atherogenic risk in both sexes. Early GH treatment would produce lipid metabolism benefits in these patients.

Effect of recovery from obesity on cardiovascular risk factors among Japanese schoolchildren: the Iwata population-based follow-up study

BACKGROUND

The effect of recovery from obesity on cardiovascular risk factors is not well understood in Japanese children.

METHODS

We analyzed follow-up data from the Iwata city population-based study of schoolchildren in Japan. The Iwata Board of Education conducted health screenings of children aged 10 and 14 years. A total of 914 children aged 10 years (451 boys and 463 girls, 87.1% of all children in the city in 1997) were followed until 14 years of age and classified by pattern of obesity as Normal, Recovered, Worsened, or Persistent.

RESULTS

Of the 914 children, 111 (12%) were obese at 10 years of age. Of those children, 44 (40%) were no longer obese at 14 years (ie, Recovered). At follow-up, Recovered boys had the greatest decrease in non-HDL cholesterol (mean ± SE, -21.3 ± 3.6 mg/dL) among the 4 groups, and Recovered girls had a significantly lower level of non-HDL cholesterol (Recovered, 107.1 ± 5.4 mg/dL vs. Persistent, 126.1 ± 4.5 mg/dL). The Recovered boys also had a significantly higher level of HDL cholesterol at age 14 (Recovered, 67.2 ± 2.7 mg/dL vs. Persistent, 53.3 ± 2.1 mg/dL). In the Recovered group, 68% of children who were dyslipidemic at baseline had normal cholesterol levels at age 14. The recovery rate from dyslipidemia was significantly higher in the Recovered group (cumulative incidence rate ratio, 2.5; 95% confidence interval, 1.4-4.7) as compared with the Persistent group.

CONCLUSIONS

Dyslipidemia was reversed in children who recovered from obesity. Our findings suggest that reducing obesity is beneficial to the health of Japanese schoolchildren.

Height-specific serum cholesterol levels in pubertal children: data from population-based Japanese school screening

Background

Inverse associations between height and serum lipid levels in pubertal children have been reported. To develop criteria for normal serum lipid levels stratified by height in pubertal children, we examined height-specific cholesterol levels, using data from a population-based school screening.

Methods

Serum levels of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were investigated in 10 151 children (98.9% of the target population) aged 10 and 14 years who attended public schools in Iwata City from 2002 through 2007.

Results

The 95th percentiles of TC in the lowest and highest quintiles of height were 221 and 219 mg/dL, respectively, in 10-year-old boys, 215 and 203 mg/dL in 14-year-old boys, 220 and 204 mg/dL in 10-year-old girls, and 226 and 214 mg/dL in 14-year-old girls. The fifth percentiles of HDL-C in the lowest and highest quintiles of height were 45 and 43 mg/dL in 10-year-old boys, 43 and 40 mg/dL in 14-year-old boys, 46 and 42 mg/dL in 10-year-old girls, and 47 and 44 mg/dL in 14-year-old girls.

Conclusions

This study provided height-specific levels of serum lipids in 10-year-old and 14-year-old children. Height should be considered when evaluating cholesterol levels in pubertal children.

Impact of leptin and leptin-receptor gene polymorphisms on serum lipids in Japanese obese children

AIM

Leptin is one of the factors affecting serum lipid profile. We investigated the association between serum lipids and leptin/leptin receptor (LEPR) gene polymorphisms in obese Japanese children.

METHODS

One hundred and thirty-six obese children (99 males and 37 females, relative weight over than 20%) from 5 to 17 years of age were recruited from 10 institutes. Four known polymorphisms in leptin gene [(+19)A G, (-2548)G A, (-188)C A, (-633)C T] and four known polymorphisms in LEPR gene [Lys109Arg, Gln223Arg, Pro(G)1019Pro(A), Ser(T)343Ser(C)] were determined using polymerase chain reaction-restriction fragment length polymorphism-based analyses.

RESULTS

No associations were found between leptin gene polymorphisms and serum lipid profile. On the other hand, Lys109Arg and Ser343Ser polymorphism in LEPR gene, but not Gln223Arg or Pro1019Pro, had significant relationships with serum lipid profile; lower total and low-density lipoprotein cholesterol levels in Arg109Arg homozygotes, and lower TG levels in Ser343Ser(C/C) homozygotes. In addition, LEPR gene also associated with relative weight; Arg109Arg homozygotes had higher relative weight and Ser343Ser(C/C) homozygotes had lower one.

CONCLUSION

These results suggest that LEPR gene polymorphisms may partly contribute to serum lipid profile in obese children.

Association between serum uric acid levels and cardiometabolic risk factors among Japanese junior high school students

BACKGROUND

The present study was designed to examine whether serum uric acid (SUA) levels were associated with cardiometabolic risk factors and to determine optimal cut-offs for SUA to identify multiple risk factors among Japanese junior high school students.

METHODS AND RESULTS

A total of 958 students (518 boys and 440 girls, aged 12.1-15.0 years) who were enrolled between April 2005 and June 2008 were divided into 4 groups according to SUA quartiles. Compared with the lowest quartile of SUA, prevalence of abdominal obesity, hypertension, and dyslipidemia was significantly increased in the highest quartile in boys and that of abdominal obesity was increased in the highest quartile in girls. The adjusted odds ratios (95% confidence interval) of the highest quartile of SUA for 2 or more cardiometabolic risk factors were 2.59 (1.16-5.79) for boys and 1.54 (0.43-5.56) for girls. Receiver operating characteristic curve analysis demonstrated that the most appropriate cut-offs for SUA to identify multiple cardiometabolic risk factors were 6.4 mg/dl for boys and 4.9 mg/dl for girls.

CONCLUSIONS

SUA was strongly associated with the prevalence of cardiometabolic risk factors among male Japanese junior high school students. The present study may provide insights into the role of SUA in the school screening system for the development of educational programs on prevention of lifestyle-related diseases among school children.

Study on the reference values of serum lipids in children aged 3-18 years old in Beijing, China

BACKGROUND

The present study was designed to explore the reference values of serum lipids in children in Beijing.

METHODS

A total of 1071 healthy children from Beijing between 3 and 18 years of age were enrolled and divided into four groups: A, 3-5-year-old group; B, 6-9-year-old group; C, 10-14-year-old group; and D, 15-18-year-old group. Blood samples were obtained from the cubital veins of the participants under a fasting condition. A Hitachi 7600 Automatic Biochemistry Analyzer was used to determine the serum levels. The cut-off points of reference values were the 75th and 95th percentiles for total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) while the 25th and 5th percentiles were used for high-density lipoprotein cholesterol (HDL-C) concentrations.

RESULTS

The highest 95th percentiles of TC among the four groups were 5.34 mmol/L for boys and 5.11 mmol/L for girls. Compared with those of boys, female TG levels were obviously higher in the 10-14-year-old group (P < 0.05) and HDL-C levels were significantly higher in the 15-18-year-old group (P < 0.05). The serum TC, HDL-C, and LDL-C all peaked during the 6-9-year-old period and then declined during the adolescent stage. Also, the serum TG continuously increased with a relative plateau during the 6-14-year-old period. Obese and overweight children had higher TG and LDL-C levels but lower HDL-C levels.

CONCLUSION

This study showed a picture of the serum lipids distribution in Chinese children and found that their TC levels were lower than those of children in Japan, Iran, and France, but were higher than those of Italian children.

Trends in body mass index, blood pressure, and serum lipids in Japanese children: Iwata population-based annual screening (1993-2008)

Background

Current trends in body size, blood pressure, and serum lipids in children are predictors of future disease prevalence. However, there have been no studies of blood pressure and high-density lipoprotein cholesterol (HDL-C) levels in Japanese children.

Methods

We investigated trends in body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), non-HDL-C, and HDL-C using data from annual screenings in 1993 through 2008. The subjects were 14 872 (98.8% of the target population) fifth-graders enrolled in all public schools in the Original Iwata area in Iwata City, Japan. The same examination protocol was used throughout to ensure the uniformity of quality control and the precision of assessment. Trends in the variables in relation to the calendar year were analyzed by using regression models.

Results

In boys, the 95th percentile of BMI increased by 0.09 kg/m²/year. In both sexes, the 5th percentile of BMI decreased by 0.02 to 0.03 kg/m²/year. There was a significant negative correlation between SBP and calendar year, and the 95th percentile of SBP decreased by 0.52 mm Hg/year in boys and by 0.40 mm Hg/year in girls. There was also a significant reduction DBP. However, there were no trends in TC, non-HDL-C, or HDL-C.

Conclusions

The increase in obese and underweight children in Original Iwata was consistent with the findings of a nationwide survey. Although high blood pressure and related risk factors were formerly a serious problem in Japan, blood pressure levels have decreased in schoolchildren from Iwata over the past 15 years.

Normal reference values for serum lipid levels in Chinese adolescents between 12 and 18 years of age

The purpose of this study was to develop representative gender- and age-specific percentile reference data for serum lipids for Chinese adolescents between 12 and 18 years of age. Blood samples were obtained from 2998 boys and 3225 girls in nine provinces from the mainland of China, including rural and urban areas. The data for serum lipid levels, including TC, TG, HDL-C and LDL-C, were calculated and measured between March and June 2008. Gender- and age-specific percentiles of serum lipid levels were calculated. Gender- and age-specific percentile-based reference data for serum lipids is presented for Chinese adolescents for the first time. The 95th percentile for the TC, TG and LDL-C levels was 5.07, 1.90 and 3.32 mmol/l, and the 5th percentile for the HDL-C level was 0.92 mmol/l among all the students. These reference values can be used to plan and implement preventive policies, and to study temporal trends.

Profiles of levels of lipids and dyslipidaemia in children from Beijing, China

BACKGROUND

There is limited data available on characteristics of profiles of lipids in children. The purpose of our investigation, therefore, was to determine the lipid profile, and analyze the prevalence of dyslipidaemia, in subgroups of children according to different gender, districts of residence, and ages in Beijing, China.

METHODS AND RESULTS

We included 18,944 school children, aged from 7 to 18 years, in our community-based cross-sectional study, measuring the levels of total cholesterol and triglyceride in capillary blood, and at the same time determining their weight and height. Weights, heights, circumference at the waist, and body mass index proved to be significantly greater for the boys than the girls. The levels of total cholesterol of boys and girls were 3.98 +/- 0.35, and 4.02 +/- 0.35 mmol/L, respectively, while the comparable levels of triglycerides were 1.08 +/- 0.52, and 1.18 +/- 0.66 mmol/L, respectively. The percentages of hypercholesterolaemia, hypertriglyceridaemia, combined dyslipidaemia, and hyperlipidaemia were 1.2, 8.8, 0.4, and 9.7%, respectively. The incidences of hypertriglyceridaemia, combined dyslipidaemia, and hyperlipidaemia of girls were higher than boys. The levels of triglycerides for boys aged from 11 to 18 years living in an urban setting were higher than those for boys living in rural settings, as were the levels of total cholesterol for boys aged from 12 to 16 years.

CONCLUSION

Our study provides the newest current profiles of lipids for children living in Beijing. We found significant influences of age, districts of residence, and genders on the levels of lipids, features which need further attention in the prevention and treatment of dyslipidaemia.

An 11-year-old boy with familial hypercholesterolemia showing multiple xanthomas and advanced atherosclerosis, who responded to lipid-lowering therapy using statin

Familial hypercholesterolemia (FH) is characterized by a high level of LDL-cholesterol (LDL-C) and a high prevalence of atherosclerotic coronary heart disease; however, hypercholesterolemia is usually the only clinical finding in children with heterozygous FH in their first decade of life. We report a case of FH in an 11-year-old boy who presented with multiple xanthomas at both elbows, thickened Achilles tendons, and hyperplasia of the intima-media complex of the carotid artery. Echocardiogram revealed partial calcification of the aortic and mitral valves, but no stenosis of the coronary arteries was detected on 3D-computed tomography. The activity of LDL receptors was reduced to 32% by lymphocyte assay. The family history showed vertical transmission of hypercholesterolemia from father to son, thereby suggesting dominant inheritance. After 12 months of treatment with statin and resin, his LDL-C decreased from 446 to 220 mg/dL, thickening of the Achilles tendons decreased from 1618 mm to 13 mm, and hyperplasia of the intima-media complex decreased from 1.3 mm to 0.7 mm. These findings suggest that our patient had heterozygous FH. However, based on his advanced atherosclerosis, we cannot exclude the possibility that our patient may be accompanying dyslipidemia due to causes in addition to heterozygous FH.

Unfavorable lipoprotein profile in childhood cancer survivors with suprasellar brain tumors--a high Apo B level and increased small dense LDL-cholesterol

OBJECTIVE

The purpose of this study is to evaluate atherosclerotic potency among childhood cancer survivors (CCS) with suprasellar tumors.

STUDY DESIGN

Patients with remitted suprasellar tumors were recruited. A total of 17 subjects with simple obesity of similar ages served as obese controls. Fasting sera were subjected to determination of lipids and apolipoproteins (Apo), including small dense LDL-cholesterol (sdLDL-C).

RESULTS

Twenty-three patients (4-22 years old) were enrolled. Patients, 12/23, had a body mass index (BMI) above the 90th percentile and were designated as 'obese patients'. Obese patients had lower BMI scores (mean 26.4 kg/m(2), p < 0.01) compared to obese controls (mean 31.5 kg/m(2)). Both groups had identical levels of total cholesterol, triglycerides, LDL-C, and HDL-C. However, obese patients were found to have a higher incidence of Apo B/Apo A1 ratio elevation (6/12) than obese controls (0/17, p < 0.01). In addition, obese patients had higher sdLDL-C level (47.6 +/- 14.8 mg/dL) than obese controls (28.3 +/- 7.1 mg/dL, p < 0.01). BMI showed strong correlations with both the Apo B/Apo A1 ratio (r = 0.663, p < 0.001) and sdLDL-C (r = 0.606, p < 0.01).

CONCLUSION

CCS with suprasellar tumors, especially patients with a high BMI, had an unfavorable lipoprotein profile characterized by increased Apo B and sdLDL-C.

Risk factors for dyslipidemia in Chinese children

AIM

Since the mortality rate due to cardiovascular disease continues to increase, research into dyslipidemia has been emphasized in not only adults but also paediatric populations. We aimed to study the risk factors of dyslipidemia in Chinese children.

METHODS

Nine hundred and sixty-two children, aged 6-18 years, in Beijing were enrolled. For each child, data were collected on body height (cm), body weight (kg), sitting height (cm), waist circumference, upper arm circumference, serum lipid levels, as well as familial history of dyslipidemia and early onset cardiovascular disease. Subgroups were determined on the basis of age and sex.

RESULTS

The prevalence rate of dyslipidemia was 11.1% (107/962). Children with dyslipidemia differed significantly from those without, in sitting height, upper arm circumference, body mass index (BMI), waist-to-height ratio (WHR) and diastolic and systolic blood pressure (p < 0.05). Logistic regression analysis suggested that WHR, diastolic blood pressure and positive familial history were risk factors for dyslipidemia in children.

CONCLUSION

Sitting height, upper arm circumference, BMI, WHR, diastolic pressure and systolic pressure were significantly higher in dyslipidemic children than in normal subjects in China. BMI, WHR, diastolic pressure and familial history of dyslipidemia and early-onset cardiovascular disease were risk factors for dyslipidemia in Chinese children.